Does a history of cannabis use influence onset and course of schizophrenia?

Significant outcomes

Schizophrenia patients with a history of cannabis use in adolescence had earlier age at onset and more severe disease in terms of hospital admissions and length of stay compared to patients without cannabis history.

Symptom profiles of schizophrenia did not seem to differ by previous cannabis history.


Limitations

We did not have data on self-reported cannabis use during follow-up.
In spite of a large national cohort, number of cases with schizophrenia was limited.




Abstract

Introduction
While evidence strongly supports a causal effect of cannabis on psychosis, it is less clear whether the symptom pattern, clinical course, and outcomes differ in cases of schizophrenia with and without a background of cannabis use.

Methods
Analysis of medical records from a longitudinal follow-up of Swedish conscripts with data on cannabis use in adolescence and subsequent incidence of schizophrenia. One hundred sixty patients with schizophrenia were assessed using the OPCRIT protocol. Cases were validated for diagnosis schizophrenia according to OPCRIT.

Results
Patients with a cannabis history (n = 32), compared to those without (n = 128), had an earlier age at onset, a higher number of hospital admissions and a higher total number of hospital days. There was no significant difference in type of onset and clinical symptom profiles between the groups.

Conclusion
Our findings indicate that the disease burden of schizophrenia is greater in individuals who use cannabis during adolescence. Strengthening evidence on causality and teasing out long-term effects of pre-illness cannabis use from continued post-illness has clinical implications for improving schizophrenia outcomes.